Effective
Date � October 1, 2007
Notice of
Privacy
Practices
This notice describes how medical information
about you may be used and disclosed and how you can get access to this
information. Please review it carefully.
We are required by law to provide you with this notice that explains our privacy practices with regard to your medical information and how we may use and disclose your protected health information for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of your protected health information and we also describe those rights in this notice.
Ways in Which We May Use
and Disclose Your Protected Health Information:
The
following paragraphs describe different ways that we use and disclose your
protected health information. We have provided an example for each category,
but these examples are not meant to be exhaustive. All of the ways we are
permitted to use and disclose your health information fall within one of these
categories.
Treatment. We
will use and disclose your protected health information to provide, coordinate,
or manage your health care and any related services. We will also disclose your
health information to other physicians who may be treating you. Additionally we
may from time to time disclose your health information to another physician
whom we have requested to be involved in your care. For example � we would
disclose your health information to a specialist to whom we have referred you
for a diagnosis to help in your treatment.
Payment. We will use and disclose your protected
health information to obtain payment for the health care services we provide
you. For example � we may include information with a bill to a third-party
payer that identifies you, your diagnosis, procedures performed, and supplies
used in rendering the service.
Health
Care Operations. We will use and disclose your protected health information
to support the business activities of our practice. For example -� we may use medical information about you to
review and evaluate our treatment and services or to evaluate our staff�s
performance while caring for you. In addition, we may disclose your health
information to third party business associates who perform billing, consulting,
or transcription, or other services for our practice.
Other Ways We May Use
and Disclose Your Protected Health Information:
Appointment
Reminders.
We will use and disclose your protected health information to contact you as a
reminder about scheduled appointments or treatment.
Treatment
Alternatives.
We will use and disclose your protected health information to tell you about or
recommend possible alternative treatments or options that may be of interest to
you.
Others
Involved in Your Care. We will
use and disclose your protected health information to a family member, a
relative, a close friend, or any other person you identify that is involved in
your medical care or payment for care.
Research. We will use and disclose your protected
health information to researchers, provided the research has been approved by
an institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your health information.
As
Required by Law. We will
use and disclose your protected health information when required to by federal,
state, or local law.
To
Avert a Serious Threat to Public Health or Safety. We
will use and disclose your protected health information to public health
authorities permitted to collect or receive the information for the purpose of
controlling disease, injury, or disability. If directed by that health
authority, we will also disclose your health information to a foreign
government agency that is collaborating with the pubic health authority.
Worker�s Compensation. We will use and disclose your protected
health information for worker�s compensation or similar programs that provide
benefits for work-related injuries or illness.
Inmates. We will use and
disclose your protected health information to a correctional institution or law
enforcement official if you are an inmate of that correctional institution or
under the custody of the law enforcement official. This information would be
necessary for the institution to provide you with health care; to protect the
health and safety of others; or for the safety and security of the correctional
institution.
Your Health Information
Rights
Although your health record is the physical property of the
practitioner or facility that compiled it, the information belongs to you. You
have the right to:
A Paper
Copy of This Notice. You have the right to receive a paper copy of
this notice upon request. You may obtain a copy by asking our receptionist at
your next visit or by calling and asking us to mail you a copy.
Inspect
and Copy. You have the right to inspect and copy the
protected health information that we maintain about you in our designated
record set for as long as we maintain that information. This designated record
set includes your medical and billing records, as well as any other records we
use for making decisions about you. Any psychotherapy notes that may have been
included in records we received about you are not available for your inspection
or copying, by law. We may charge you a fee for the costs of copying, mailing,
or other supplies used in fulfilling your request.
Request
Amendment.
You have the
right to request that we amend your medical information if you feel that it is
incomplete or inaccurate. You must make this request in writing to our practice
manager, stating exactly what information is incomplete or inaccurate and the
reasoning that supports your request.
We are
permitted to deny your request if it is not in writing or does not include a
reason to support the request. We may also deny your request if:
� The information was not
created by us, or the person who created it is no longer available to make the
amendment.
� The information is not
part of the record which you are permitted to inspect and copy.
� The information is not
part of the designated record set kept by this practice or if it is the opinion
of the opinion of the health care provider that the information is accurate and
complete.
Request
Restrictions.
You have the
right to request a restriction of how we use or disclose your medical
information for treatment, payment, or health care operations. For example �
you could request that we not disclose information about a prior treatment to a
family member or friend who may be involved in your care or payment for care.
Your request must be made in writing to our practice manager.
We are not
required to agree to your request if we feel it is in your best interest to use
or disclose that information. If we do agree, we will comply with your request
except for emergency treatment.
An
Accounting of Disclosures. You have the right to
request a list of the disclosures of your health information we have made
outside of our practice that were not for treatment, payment, or health care
operations. You request must be in writing and must state the time period for
the requested information. You may not request information for any dates prior
to April 14, 2003, nor for a period of time greater than six years (our legal
obligation to retain information).
Your first request for a list of disclosures within a
12-month period will be free. If you request an addition list within 12-months
of the first request, we may charge you a fee for the costs of providing the
subsequent list. We will notify you of such costs and afford you the
opportunity to withdraw your request before any costs are incurred.
Request
Confidential Communications. You have the right to
request how we communicate with you to preserve your privacy. For example � you
may request that we call you only at your work number, or by mail at a special
address or postal box. Your request must be made in writing and must specify
how or where we are to contact you. We will accommodate all reasonable
requests.
File a
Complaint.
If you believe we have violated your medical information
privacy rights, you have the right to file a complaint with our practice or
directly to the Secretary of Heath and Human Services.
To file a complaint with our manager, you must make it in
writing within 180 days of the suspected violation. Provide as much detail as
you can about the suspected violation and send it to our Privacy Officer.
Uses or Disclosures Not
Covered
Uses
or disclosures of your health information not covered by this notice or the
laws that apply to us may only be made with your written authorization. You may
revoke such authorization in writing at any time and we will no longer disclose
health information about you for the reasons stated in your written
authorization. Disclosures made in reliance on the authorization prior to the
revocation are not affected by the revocation.
For More Information
If you
have questions or would like additional information, you may contact our
Privacy Officer.